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Ametaj AA, Denckla CA, Stevenson A, Stroud RE, Hall J, Ongeri L, Milkias B, Hoffman J, Naisanga M, Akena D, Kyebuzibwa J, Kwobah EK, Atwoli L, Gichuru S, Teferra S, Alemayehu M, Zingela Z, Stein DJ, Pretorius A, Newton CR, Mwema RM, Kariuki SM, Koenen KC, Gelaye B. Cross-cultural equivalence of the Kessler Psychological Distress Scale (K10) across four African countries in a multi-national study of adults. SSM - MENTAL HEALTH 2024; 5:100300. [PMID: 38706931 PMCID: PMC11064105 DOI: 10.1016/j.ssmmh.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all. Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confirmatory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries. Monte Carlo simulations showed a correlation of 0.998, a good replication of population values, indicating minimal noninvariance, or variation. Items "so nervous," "lack of energy/effortful tasks," and "tired" were consistently equivalent for intercepts and factor loadings, respectively. However, items "depressed" and "so depressed" consistently differed across study countries (R2 = 0) for intercepts and factor loadings for both items. The K10 scale likely functions equivalently across the four countries for most items, except "depressed" and "so depressed." Differences in K10 items were more common in Kenya and Ethiopia, suggesting cultural context may influence the interpretation of some items and the potential need for cultural adaptations in these countries.
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Affiliation(s)
- Amantia A. Ametaj
- Institute of Health Equity and Social Justice, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rocky E. Stroud
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jasmine Hall
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Barkot Milkias
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jacob Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Molly Naisanga
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | - Edith K. Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Stella Gichuru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkam Alemayehu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zukiswa Zingela
- Executive Dean’s Office, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Adele Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charles R.J.C. Newton
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rehema M. Mwema
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
| | - Symon M. Kariuki
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bizu Gelaye
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Lim G, Bourne A, Hill A, McNair R, Lyons A, Amos N. Community connection is associated with lower psychological distress for sexual minority women who view community connection positively. CULTURE, HEALTH & SEXUALITY 2024; 26:513-530. [PMID: 37452686 DOI: 10.1080/13691058.2023.2231043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
We examined factors associated with sexual minority women's evaluations of belonging to the lesbian, gay, bisexual, transgender and queer (LGBTQ) community in Australia, and assessed whether a positive view of community participation impacted levels of psychological distress. 2424 cisgender sexual minority women participated in a national, online, cross-sectional survey of LGBTIQ adult Australians' health and well-being. Multivariable regression analyses were conducted to investigate sociodemographic factors associated with sexual minority women's belonging to the LGBTQ community, feelings towards community connection, and associations between community connection and recent psychological distress. Most sexual minority women (58.9%) reported feeling that they are part of the LGBTQ community, and a majority of the participants felt positive about being connected to this community (68.5%). Participants who were bisexual, non-university educated, and who resided in an outer-suburban location were least likely to evaluate participation in the LGBTQ community positively. Feeling positive about community connection was associated with lower levels of psychological distress. Feeling a part of LGBTQ community was associated with lower psychological distress, but this link appears contingent upon positive feelings about community participation. Sexual minority women's' relationships to the LGBTQ community are often complex, and community connection and participation in and of itself is not a panacea for the negative outcomes associated with sexual minority stressors.
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Affiliation(s)
- Gene Lim
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Adam Bourne
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Adam Hill
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Lyons
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Amos
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
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Hoffman J, Cossie Q, Ametaj AA, Kim HH, James R, Stroud RE, Stevenson A, Zingela Z, Stein DJ, Gelaye B. Construct validity and factor structure of the Kessler-10 in South Africa. BMC Psychol 2022; 10:177. [PMID: 35851071 PMCID: PMC9290237 DOI: 10.1186/s40359-022-00883-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background The Kessler Psychological Distress Scale (K-10) is a short screening tool developed to identify, with good sensitivity, non-specific psychological distress in the general population. Sensitivity and specificity of the K-10 have been examined in various clinical populations in South Africa; however, other psychometric properties, such as construct validity and factor structure, have not been evaluated. We present evidence of the prevalence and severity of psychological distress in an outpatient setting in South Africa and evaluate the internal reliability, construct validity, and factor structure of the K-10 in this population. Methods We explored prevalence estimates of psychological distress using previously established cutoffs and assessed the reliability (consistency) of the K-10 by calculating Cronbach’s alpha, item-total correlations and omega total and hierarchical coefficients. Construct validity and factor structure of the K-10 were examined through split-sample exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA), comparing several theoretical models and the EFA. Results Overall, there was low prevalence of psychological distress in our sample of 2591 adults, the majority of whom were between the ages of 18–44 (77.7%). The K-10 showed good construct validity and reliability, with a Cronbach’s alpha of 0.84 and omega total of 0.88. EFA yielded a four-factor solution with likely measurement artifacts. CFA showed that the four-factor model from EFA displayed the best comparative fit indices, but was likely overfitted. The unidimensional model with correlated errors was deemed the best fitting model based on fit indices, prior theory, and previous studies. Conclusion The K-10 displays adequate psychometric properties, good internal reliability, and good fit with a unidimensional-factor structure with correlated errors. Further work is required to determine appropriate cutoff values in different populations and clinical subgroups within South Africa to aid in determining the K-10’s clinical utility.
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Affiliation(s)
- Jacob Hoffman
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa. .,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. .,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Qhama Cossie
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Amantia A Ametaj
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hannah H Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roxanne James
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Rocky E Stroud
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Zukiswa Zingela
- Psychology Department, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dan J Stein
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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